The Association Beween NON-Cancer-Related Delayed Dental Healing and Bisphosphonate Use: A Case-Control Study

Presentation Number: SAT-266
Date of Presentation: June 15th, 2013

John Dennis Wark*1, Caroline Brand2, JOHN Clement3, Michael McCULLOUGH3, Lisa Crighton4, Graham Hepworth2 and Gelsomina Borromeo2
1Univ of Melbourne, Melbourne VIC, Australia, 2The University of Melburne / Royal Melbourne Hospital, PARKVILLE, Australia, 3The University of Melburne / Royal Melbourne Hospital, Carlton, Australia, 4The University of Melburne / Royal Melbourne Hospital

Abstract

Osteonecrosis of the jaw (ONJ) is an uncommon but well-recognised destructive lesion that has been linked with bisphosphonate exposure in oncology patients. Uncertainty persists regarding the association between bisphosphonate  use and ONJ [or delayed dental healing (DDH), defined as failure of a dental wound to heal within 6 weeks with standard dental care] in patients being treated for non-cancer-related bone disease. In a recent case-control study, we found a 13-fold increase in the odds of DDH associated with recorded bisphosphonate use (P < 0.001). 

 This study was conducted in the State of Victoria, Australia: 4212 patients aged over 50 years seen by a dental specialist (oral and maxillofacial surgeon or special needs dentist)  during a 6 month period in 2006 were compared with age- and gender-matched controls also matched for referral source (4 controls/case). History of cancer or local radiotherapy was an exclusion. Of the 40 DDH cases confirmed by a blinded adjudication panel, 21 had a record of bisphosphonate  use (20 alendronate users, 1 risedronate user, no intravenous bisphosphonate  recipients). All bisphosphonate -associated cases also met the definition of ONJ (> 8 weeks without healing).  Having a medical condition not directly related to bisphosphonate use (e.g., cardiovascular, respiratory or renal disease) was a weak independent predictor of DDH (OR 2.3, 95% CI 1.0 to 5.2, P = 0.04). Smoking and low socioeconomic status also were risk factors for DDH. 39 of 40 DDH cases had a recorded dental procedure (e.g., dental extraction, implant, implant failure) as a possible precipitant. The estimated prevalence of DDH in patients aged > 50 years, taking a bisphosphonate and attending a dental specialist was 3.5 % (slightly under 1 in 30). This case-control study provides unique new information supporting a clinically-relevant association between oral bisphosphonate therapy and delayed dental healing/jaw osteonecrosis in patients with non-cancer-related bone disease. Importantly, a dental procedure was identified as a precipitant of DDH in almost all cases.  More research is needed to define the incidence and to further characterise risk factors for DDH and ONJ in this large segment of the population.

 

Disclosure: JDW: Consultant, Amgen, Principal Investigator, Eli Lilly & Company, Principal Investigator, Eli Lilly & Company, Consultant, Merck & Co., Principal Investigator, Merck & Co., Consultant, Novartis Pharmaceuticals, Principal Investigator, Novartis Pharmaceuticals, Consultant, Sanofi, Principal Investigator, Sanofi, Consultant, Servier, Principal Investigator, Servier, Speaker, Eli Lilly & Company, Speaker, Novartis Pharmaceuticals, Speaker, Servier. Nothing to Disclose: CB, JC, MM, LC, GH, GB